Dosimetric assessment of occupational exposure during percutaneous nephrolithotomy using Monte Carlo simulation

Abstract

This research focuses on estimating the radiation doses delivered to the main and assistant physicians during percutaneous nephrolithotomy (PCNL) via computer modeling. To achieve this, scenarios were simulated using the Monte Carlo N-Particle 6.2 code in a simulated PCNL procedure setting. The scenarios varied according to the anteroposterior (AP), right anterior oblique, 30° (RAO30) and left anterior oblique, 30° (LAO30) projections. Variations in body mass index (BMI) were modeled using two virtual anthropomorphic phantoms. These different phantoms were employed to study the influence of the BMI factor on the scattered radiation by the patient. The study also assessed the impact of personal protective equipment (PPE) and collective protective equipment (CPE) on reducing radiation doses for the main physician and assistant. The physician and assistant were simulated using a MASH3 virtual phantom. The Siemens SIREMOBIL Compact L fluoroscopic device was modeled, the tube voltage value for all scenarios was 70 kV, as well as the field size was 11 × 11 cm², and the experimental kerma-area product was equal to 27 Gy⋅cm². The effective doses obtained for the main physician ranged from 0.92 to 41.47 μSv. The use of PPE and CPE reduced the effective dose by 94 %. The equivalent doses found for the main physician's eyes varied in a range of 0.172–7.34 mSv, and the use of PPE and CPE resulted in a 98 % reduction in eye dose. The effective doses obtained for the assistant ranged from 0.33 to 13.49 μSv. In all simulated scenarios, the main physician receives an effective dose up to 71 % higher than the assistant. Our study found that oblique projections resulted in higher radiation exposure for the main physician, with the LAO30 projection increasing the dose by 51 % compared to the AP projection.